KinGdom of MediCine 💊 مملكة الطب:
#Biochemistery
#Carbohydrate_metabolism
#بوست_رقم (19)
في البوست الفات عرفنا ال normal blood glucose
الليلة ان شاء الله ح نتكلم عن ال
Abnormalities of blood glucose
واول حاجه ح نتكلم عن
🌸 Hypoglycemia:
🍁 Definition:
It is decrease of blood glucose concentration below normal.
🍁 Effect:
1. Causes cerebral dysfunction
لانه زي ماعرفنا ال brain وال nervous tissues بتعتمد علي ال glucose.
2. If hypoglycemia is sever and prolonged, it cause coma (hypoglycemic coma) and then death.
🍁 Mechanism that corrects hypoglycemia: hypoglycemia activates:-
يعني ال low blood glucose ح يعمل activates ل :-
1. a- cells of iselt of langerhans
ودا عرفنا في البوست الفات انها مسؤولة من انها تطلع لي ال Glucagon ف بنطلعو عشان نكسر الجلكوز وبالتالي نزيد معدل الجلكوز في الدم.
2. Receptors in hypothalamus: This stimulates:
1. Secretion of epinephrine —> increase Glycogenolysis —> increase blood glucose.
2. Secretion of anterior pituitary hormones :
a. growth hormone:
اللي هو دا عبارة عن insulin antagonist.
b. ACTH (Adrenocorticotrophic hormone):
ودا بعمل stimulation لل suprarenal cortex عشان تطلع glucocorticoids و بكدا ح يزيد ال Gluconeogensis وبالتالي ح يزيد ال blood glucose
🔥Note:
Glucagon and epinephrine are most important in the acute,short term regulation of blood glucose levels , but glucocorticoids and growth hormone play a role in long term regulation of blood glucose level.
🌸 Symptoms:
1. Adrenegic symptoms:
ودي بتحصل بسبب زيادة ال epinephrine اللي هي
1. Anxiety. 2. Palpitation. 3. Tremors. 4. Sweating. 5. Hunger.
2. Symptoms due to impaired glucose supply to the brain (impairment of brain function):
1. Headache. 2. Confusion. 3. Slurred speech. 4. Coma and death.
🌸 Types of hypoglycemia:
عندنا نوعين من ال hypoglycemia اللي هم
1. Fasting hypoglycemia.
2. Stimulative (reactive) hypoglycemia.
ح نشوفهم بالتفصيل واحد واحد
🌺 Fasting hypoglycemia:
It is the inability to maintain normal glucose concentration in the fasting state.
بكون غالبا نتيجة ل organ diseases
☘ Causes:
1. Pancreatic disease:
اي disorders تأثر لي علي ال B cells زي ال insulinoma اللي هي pacreatic B cell tumor بالتالي ح تزيد ال insulin secretion
2. Liver diseases:
ح تؤدي ل decrease of glycogenolysis and gluconeogensis
ال liver disease زي شنو؟؟
1. Hepatocellular damage e.g. hepatic carcinoma.
2. Glycogen storage diseases.
3. Prolonged starvation: due to depletion of liver glycogen.
3. Adrenocortical diseases:
Lead to decreased secretion of epinephrine (decrease glycogenolysis) and glucocorticoids (decrease gluconeogensis).
4. Fasting blood glucose may be reduced in
1.hypoactivity of thyroids (Myxoedema and cretinism).
2. Hypopituitarism (Simmond's disease).
3. Hypoadrenalism (Addison's disease).
🌺 Stimulative (reactive) hypoglycemia:
It occurs due to some stimuli usually after taking a meal.
☘ Causes:
a) Drugs and poisons:
1. Therapeutic insulin administration: over dosage of insulin during treatment of diabetes can lead to hypoglycemia.
2. Over dosage of sulphonylurea: it is oral hypoglycemic drug that stimulates B-cells to produce insulin.
3. Liver poisons: as chloroform and phosphorus.
4. Alcohol (ethanol) ingestion:
ودا شائع في ال excessive alcohol ingestion
طيب كيف بحصل ال hypoglycemia بواسطة ال alcohol ingestion
لما يحصل Metabolism of alcohol —> ح يزيد ال NADH +H levels في ال liver وبالتالي ح يحصل inhibition لل gluconeogensis وبكدا ح يحصل ال hypoglycemia.
b) Postgastrectomy (removal of stomach):
Glucose is absorbed rapidly which leads to stimulation of excessive insulin secretion.
C) Leucine hypersensitivity of infancy and childhood:
ال leucine amino acid الموجود في ال diet بعمل stimulate لل B-cells عشان تعمل secretion لل insulin.
In sensitive infants there is excessive insulin release.
d) Inborn errors of metabolism: as in:
1. Galactosemia:
Due to deficiency of galactose-1-P uridyl transferase.
2. Hereditary fructose intolerance:
Due to deficiency of aldolase B enzyme —> inhibition of phosphorylase —>inhibition of glycogenolysis.
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